Full Practice Authority: More Autonomy, More Risk
You've waited years for full practice authority (FPA). The ability to diagnose, treat, and prescribe without a physician's signature. Now that it's here—or coming soon—you might be wondering: does this mean I need more insurance?
Short answer: yes. FPA shifts liability from the collaborating physician squarely onto you. And if you're relying on your employer's policy, you could be dangerously underprotected.
What Full Practice Authority Actually Means for Your Liability
Under FPA, you practice independently—no collaborative agreement, no supervising doc. That means if a patient alleges misdiagnosis, improper prescribing, or failure to refer, you're the one on the hook. The facility's lawyer represents the facility, not you. And employer policies often exclude license defense, which can cost $25,000 or more per incident.
According to NSO, scope-of-practice allegations jumped from 0.5% of closed NP claims in 2012 to 4.2% in 2017, with an average paid indemnity of $146,250. As more states adopt FPA, that number will likely climb.
Is Your Employer's Policy Enough?
Probably not. Employer policies are designed to protect the employer. They typically:
- End when you leave the job (no tail coverage)
- Exclude license board defense
- Allow the insurer to settle without your consent
- Limit coverage to acts within your job description—but who defines that?
If you're an independent NP or work in a state with FPA, you need your own policy. Period.
How Much Coverage Do You Need?
Most NPs carry $1 million per occurrence / $3 million aggregate. For independent NPs, some experts recommend $1M/$6M. Annual premiums typically range from about $990 to $2,000, depending on your location, specialty, and claims history.
Carriers like HPSO and Proliability offer occurrence policies—which cover claims from incidents that happened while the policy was active, even if the claim is filed years later. No tail needed. That's a big deal if you change jobs or retire.
Occurrence vs. Claims-Made: Why It Matters for NPs
Occurrence: You're covered for any incident that occurred during the policy period, regardless of when the claim is filed. No extra cost when you leave.
Claims-made: You're only covered if the policy is active when the claim is filed. If you cancel or switch, you'll need tail coverage—often 1.5–2 times your annual premium.
For NPs with FPA, occurrence policies are generally the safer bet. Berxi and CM&F Group both offer occurrence options with defense costs outside the limits, meaning your policy limit isn't eaten up by legal fees.
What About License Defense?
Even if no malpractice claim is filed, a patient complaint to the state board can trigger an investigation. Defending your license can cost $10,000–$25,000. Employer policies rarely cover this. Most standalone NP policies include license defense coverage—HPSO offers up to $25,000, Proliability up to $25,000 per incident, and CPH & Associates includes $35,000.
Do You Need Higher Limits as an Independent NP?
If you own your practice or work in a high-risk specialty (e.g., psychiatric mental health, acute care), consider $1M/$6M. The extra $3 million in aggregate coverage costs relatively little more—often under $200 per year. And it can mean the difference between a manageable lawsuit and financial ruin.
Which Carrier Is Best for NPs?
There's no single "best" carrier—it depends on your practice setting, state, and budget. Here's a quick comparison of the major players:
| Carrier | Policy Type | Key Features |
|---|---|---|
| HPSO | Occurrence | $1M/$6M limits, license defense up to $25k, portable |
| Proliability | Occurrence | AANP-sponsored, board reimbursement $25k, HIPAA $50k |
| Berxi | Occurrence & Claims-made | Defense outside limits, $0 deductible, reputation coverage |
| CM&F Group | Occurrence | Portable, telemedicine included, license defense included |
| CPH & Associates | Occurrence | State Licensing Board Defense $35k, A++ rated |
What About a Collaborating Physician's Policy?
If you're still in a reduced-practice state and have a collaborating physician, their policy may cover you—but only for acts performed under their supervision. Once you gain FPA, that coverage vanishes. And even with supervision, their insurer may deny your claim if you acted beyond the scope of the agreement.
Bottom line: never rely solely on someone else's policy.
States with Full Practice Authority (as of 2026)
As of mid-2026, approximately 30 states and Washington, D.C., have enacted FPA. Recent additions include New Jersey and Oklahoma. For the latest map, check the AANP State Practice Environment map.
Final Caveat
The numbers in this article are estimates. Your actual premium depends on your exact location, specialty, claims history, and chosen limits. Always get a personalized quote from at least two carriers before purchasing.
But don't wait until you're sued. With FPA, your risk is real—and your own policy is the only thing standing between you and a six-figure judgment.